Peptic Ulcer Disease

Alternate Names
gastric ulcer
stomach ulcer
duodenal ulcer

Definition of Peptic Ulcer Disease

Peptic ulcer disease occurs when the lining of the stomach or duodenum (rarely jejunum) is worn away and produces a hole. The damage may be caused by a bacterial infection, or a combination of stomach acid and other contributing factors.

What is going on in the body?

Peptic ulcer disease usually occurs in the stomach and upper part of the small intestine, called the duodenum.

What are the signs and symptoms of the condition?

Peptic ulcer disease may not cause symptoms. When symptoms do occur, they may include:

• black, tar-like, or maroon-colored stools (from digested blood)
• actual blood in the stool or in vomit
• burning or gnawing pain in the stomach, the chest, or the back
• nausea
• stomach pain or discomfort , also known as epigastric pain or "dyspepsia."
• vomiting
• weight loss
• anemia, if there is blood loss.

What are the causes and risks of the condition?

Although stomach acid plays a role in peptic ulcer disease, a bacterial infection, Helicobacter pylori, and medications (so-called "non-steroidal" pain medications or NSAIDS like ibuprofen and aspirin) are the two major causes and account for more than 90% of peptic ulcer disease. Each of these factors breaks down the natural protective lining of the digestive tract and exposes it to acid. Inherited factors may also play a role in ulcer formation.

What can be done to prevent the condition?

Prevention of peptic ulcer disease includes:

• avoiding or limiting use of aspirin and NSAIDs.
• Eradicating H. pylori if infection is present
• prescribing medications called proton pump inhibitors, or PPIs, with NSAIDS or aspirin to prevent ulcers before they form.

How is the condition diagnosed?

The medical history may provide enough information to suspect an ulcer. If necessary, endoscopy can confirm the diagnosis.

Endoscopy is a procedure that involves putting a thin telescope into the mouth. This telescope can be moved down into the stomach and bowels. This procedure allows the doctor to directly see any ulcers that may be present. The doctor may take samples of the stomach to test for H pylori infection.

H. pylori can also be diagnosed by blood tests. Some healthcare professionals take a "test and treat" approach to peptic ulcer disease. This means that if a patient has typical symptoms of an ulcer but no evidence of a serious disease like cancer ("alarm" symptoms for serious disease include patients older than 55 years, weight loss, anemia or bleeding, vomiting, dysphagia or trouble swallowing), they may be treated without endoscopy.A test called a "heme-occult" may be done to look for blood in the stool. If they are positive for H. pylori, they receive antibiotics, if not, they receive a medication called a "proton pump inhibitor" like omeprazole. If they do not get better only then do they get endoscopy.

What are the long-term effects of the condition?

Untreated peptic ulcer disease may cause bleeding, pain, a hole in the stomach or duodenum, or weight loss.

What are the risks to others?

In areas with poor living conditions and sanitation, people can transmit H. pylori (a risk for ulcer disease) by poor hygiene (usually a lack of hand washing). This may be especially common in households with children.

What are the treatments for the condition?

Treatment for peptic ulcer disease depends on the cause. If aspirin or other medicines (NSAIDS) are responsible, then these medicines may be stopped, unless they are essential to treat an underlying disease (such as aspirin for heart disease). Some healthcare professionals will substitute a different NSAID (a so-called COX-2 inhibitor).

Smoking and alcohol should probably be stopped, because they delay the healing of ulcers. Other medicines may be given with aspirin and NSAIDS to help protect the stomach lining while these medications are prescribed. Most of these medicines work by neutralizing stomach acid or preventing it from being made.

If an infection with H pylori is diagnosed, antibiotics are given, often 3-4 for as long as 7-10 days.

Surgery may be needed for severe ulcers that bleed, don't respond to medicine, or cause a hole in the gut.

What are the side effects of the treatments?

Medications used to treat peptic ulcers, especially antibiotics, may cause allergic reactions or rash. The medications that suppress acid secretion have few if any side effects. Surgery can cause bleeding, infection, or a reaction to anesthesia.

What happens after treatment for the condition?

With proper diagnosis and treatment, peptic ulcer disease can often be cured. A cure means that there is complete healing of the ulcer and the patient's discomfort disappears.

However, if ulcers are severe or complications occur, especially bleeding, surgery or endoscopy with an instrument that burns (cauterizes) the ulcer may be needed

How is the condition monitored?

A follow-up endoscopy may confirm that an ulcer is healed. Endoscopy can rule out stomach cancer, which sometimes causes an ulcer especially in those with "alarm symptoms." A test that stains for blood in the stool (called a heme-occult) may be used.

A breath test can confirm the cure of H. pylori infection.

Any new or worsening symptoms, especially from the alarm set, should be reported to the healthcare professional.